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Annexure S1
Page 1
Application for Allotment of Permanent Retirement Account Number (PRAN)
(To avoid mistake(s), please follow the accompanying instructions and examples carefully before filling up the form)
Acknowledgement No.
(To be filled by FC)
To affix recent
Coloured photograph
(3.5 cm × 2.5 cm)
Permanent Retirement Account Number :
(To be filled by FC after PRAN generation )
Sir/Madam,
I hereby request that a permanent retirement account number be allotted to me.
I give below necessary particulars :
Section A - Subscribers Personal Details ( * Indicates Mandatory Field)
1. Full Name (Full expanded name: initials are not permitted)
Please Tick as applicable,
Shri
Smt.
First Name *
Kumari
Middle Name
Last Name
2. Gender * Please Tick as applicable,
Male
Female
3. Date of Birth *
4. PAN
D
D
M M
Y
Y
Y
Y
(Date of Birth to be Certified by DDO)
5. Father’s Full Name:
First Name *
Middle Name
Last Name
6. Present Address:
Flat/Unit No, Block no. *
Name of Premise/Building/Village
Area/Locality/Taluka
District/Town/City *
State / Union Territory *
Country *
Pin Code *
7. Permanent Address: If same as above, Please Tick
Flat/Unit No, Block no. *
else,
Name of Premise/Building/Village
Area/Locality/Taluka
District/Town/City *
State / Union Territory *
Country *
Pin Code *
8. Phone No.
STD Code
9. Mobile No.
Phone No.
Signature/Left Thumb Impression
of Subscriber in black ink
Page 2
Annexure S1
10. Email ID
11. Subscribers Bank Details: Please refer instruction no. f (4)
Bank A/c Number
Savings A/c
Current A/c
Bank Name
Bank Branch
Bank Address
Pin Code
Bank MICR Code
(Wherever applicable)
12. Value Added Services:
i) SMS Alert
Yes
No
ii) Email Alert:
Yes
No
I _____________________________________________________________ , the applicant, do hereby declare that
what is stated above is true to the best of my information & belief.
Date :
D D
M
M
Y
Y
Y
Signature/Left Thumb
Impression of Subscriber
Y
Section B - Subscribers Employment Details to be filled and attested by DDO (All Details are Mandatory)
1. Date of Joining
2. Date of Retirement
D
D
M
M
Y
Y
Y
Y
D
3. PPAN
D
M
M
Y
Y
Y
Y
(Please refer to instructions No.5.)
4. Group of the Employee (Please Tick)
Group A
Group B
Group C
Group D
5. Office
6. Department
7. Ministry
8. DDO Registration Number
9. DTO Registration Number
(Please refer to instructions No.6.)
10. Basic Salary
11. Pay Scale
Certified that the above declaration has been signed / thumb impressed before me by _______________________________________________________
after he / she has read the entries / entries have been read over to him / her by me and got confirmed by him / her. Also certified that the date of birth and employment
details is as per employee records available with the Department.
Signature of the Authorised Person
Designation of the Authorised Person : _________________________________
Rubber Stamp of the DDO
Name of the DDO ______________________
Date :
D
D
M
M
Y
Y
Y
Y
Department / Ministry _______________________
Annexure S1
Page 3
Section C - Subscriber’s Nomination Details (* Indicates Mandatory Field for nominee)
1. Name of the Nominee *:
1st Nominee
First Name *
First Name *
3rd Nominee
First Name *
Middle Name
Middle Name
Middle Name
Last Name
Last Name
Last Name
2. Date of Birth (In case of a minor)*:
1st Nominee
2nd Nominee
3rd Nominee
3. Relationship with the Nominee*:
1st Nominee
2nd Nominee
3rd Nominee
2nd Nominee
4. Percentage Share *:
1st Nominee
% 2nd Nominee
5. Nominee’s Guardian Details (in case of a minor)*:
1st Nominee’s Guardian Details
First Name *
2nd Nominee’s Guardian Details
First Name *
%
3rd Nominee
3rd Nominee’s Guardian Details
First Name *
Middle Name
Middle Name
Middle Name
Last Name
Last Name
Last Name
6. Conditions rendering nomination invalid:
1st Nominee
2nd Nominee
%
3rd Nominee
Section D - Subscriber Scheme Details
1st Scheme
Pension Fund Managers Name/Code
2nd Scheme
Pension Fund Managers Name/Code
3rd Scheme
Pension Fund Managers Name/Code
Scheme ID No./Name
Scheme ID No./Name
Scheme ID No./Name
Percentage Share
%
Percentage Share
%
Percentage Share
%
Section E - Declaration
I understand that there would be PFRDA approved Terms and Conditions for Subscribers on the CRA website governing IPin (to access CRA / NPSCAN and view details) & T-pin. I agree to be bound by the said terms and conditions and understand
that CRA may, as approved by PFRDA, amend any of the services completely or partially without any new
Declaration/Undertaking being signed.
I _________________________________________________________________ , the applicant, do hereby declare that
what is stated above is true to the best of my information & belief.
Date :
D
D
M M
Y
Y
Y Y
Signature/Left Thumb
Impression of Subscriber
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Annexure S1
INSTRUCTIONS FOR FILLING PRAN FORM
a)
b)
c)
d)
e)
f)
g)
This form is to be used by State Governments and Union Territories employees.
Form to be filled legibly in BLOCK LETTERS and in BLACK INK only.
Details Marked with (*) are the mandatory fields.
Each box, wherever provided, should contain only one character (alphabet/number/punctuation mark) leaving a blank box after each word.
'Individual' Subscriber should affix a recent colour photograph (size 3.5 cm x 2.5 cm) in the space provided on the form. The photograph should not
be stapled or clipped to the form. (The clarity of image on PRAN card will depend on the quality and clarity of photograph affixed on the form.)
Signature /Left thumb impression should only be within the box provided in the form. The signature should not be on the photograph. If there is any
mark on the photograph such that it hinders the clear visibility of the face of the Subscriber, the application will not be accepted.
Thumb impression, if used, should be attested by a Magistrate or a Notary Public or a Gazetted Officer under official seal and stamp.
Sr.
No.
Item No
1
2
3.
6.
3
8, 9, 10
4
11
Item Details
Guidelines for Filling the Form
Section A - Subscribers Personal Details
Date of Birth
All Dates Should be in “DDMMYYYY” Format
Present Address
All future communications will be sent to present address.
Phone No., Mobile No,
It is advisable to mention either “Telephone number” or “Mobile number” or “Email
& Email ID
id” so that Subscriber can be contacted in future for any discrepancy.
Subscriber’s Bank
Details
If Subscribers mentions any of the bank details, except MICR Code all the bank
details will be mandatory.
Section B - Subscribers Employment Details
It is mandatory to fill the Subscriber’s Employment details in the application. The employment details should be filled by the respective DDO of the
Subscriber and should be verified by the Authorised Signatory.
DDO should ratify Overwriting / Striking off of any of the employment details.
Kindly provide the PPAN (Permanent Pension Account Number) or equivalent
5
3.
PPAN
number, if it has been allotted to the subscriber by the respective state government /
Union Territory.
6
8&9
7
4.
8
5.
DTO Reg. No. & DDO
Reg. No.
DTO Reg. No. and DDO Reg. No. is the unique Registration number allotted by
Central Recordkeeping Agency.
Section C - Subscriber’s Nomination Details
Subscriber can nominate maximum of three nominees.
Subscriber can not fill the same nominee details more than once.
Percentage share value for all the nominees must be integer. Fractional value will not
Percentage Share
be accepted.
Sum of percentage share across all the nominees must be equal to 100. If sum of
percentage is not equal to 100, entire nomination will be rejected.
Nominee’s Guardian
If a nominee is a minor, then nominee’s guardian details will be mandatory.
Details
Section D - Subscriber scheme details
If the Subscriber is unable to mention the Scheme details i.e. PFM Name, Scheme Name & Percentage Allocation he can contact the nearest
Facilitation Centre (FC) for information or the Subscriber can also search for the scheme details on http://www.npscra.nsdl.co.in
Subscriber can select maximum three schemes. Details of the schemes are available on
http://www.npscra.nsdl.co.in
Subscriber can not fill the same scheme details more than once.
9
Scheme
If a scheme name is filled in the form for scheme setup there must be a PFM name and percentage contribution
filled for that scheme.
If the Scheme details are not filled, default scheme as approved by PFRDA will be applicable.
Scheme Contribution Value will be in terms of percentage. It cannot be in terms of amount.
Percentage contribution value for all the schemes must be integer. Fractional value will not be accepted.
10
Percentage Share
If the sum of contributions (in percentage) across all the schemes is not equal to 100, the balance will be allotted
to the default scheme approved by PFRDA.
a)
b)
c)
d)
GENERAL INFORMATION FOR PRAN SUBSCRIBERS
Subscribers can obtain the application form for PRAN in the format prescribed by PFRDA (Pension Fund Regulatory & Development Authority)
from DDO or can freely download from the CRA website (http://www.npscra.nsdl.co.in).
The request for a reprint of PRAN card with the same PRAN details or/and changes or correction in PRAN data can be made by filling up
'Request for change/correction in subscriber master details and/or re-issue of I-Pin/T-Pin/PRAN card’ or/and ‘Request For change in
signature and/or change in photograph’. The form is available from the sources mentioned in (a) above.
The Subscriber can obtain the status of his/her application from the CRA website or through the respective DTO.
For more information
Visit us at http://www.npscra.nsdl.co.in
Call us at 022-24994200
e-mail us at [email protected]
Write to: Central Recordkeeping Agency, National Securities Depository Limited, 4th Floor, ‘A’ Wing, Trade World, Kamala Mills
Compound, Senapati Bapat Marg, Lower Parel (W), Mumbai - 400 013.